Dermatolipectomy In Patients With Postoperative Ventral Hernia Under Morbid Obesity
DOI:
https://doi.org/10.11603/2414-4533.2017.1.7333Keywords:
postoperative ventral hernia, morbid obesity, dermatolipectomy.Abstract
The aim of the work: to develop the tactical preconditions of reconstructive abdomenoplastiky and hernia repair with possible correction options of musculo-aponeurotic layer of the anterior abdominal wall and an adequate choice of the mesh implant, and taking into account the anatomical and functional changes in the field of surgery.
Materials and Methods. We analyzed results of surgical treatment of 46 patients with postoperative ventral hernia (POVH) with concomitant morbid obesity in terms both of the allogernioplasty and dermatolipectomy and, taking into account the results of the studies of the blood supply to the subcutaneous fat layer of the anterior abdominal wall in patients with different BMI. The study of hemodynamics of the anterior abdominal wall in patients with different BMI allowed us to identify areas with intensive and less intensive blood supply, research vessels with different diameter and blood velocity. This was the evidence base area selection gentle mobilization of subcutaneous fat in the performance of dermatolipectomy.
Results and Discussion. In patients with existing III and IV obesity state with a BMI of 30–40 and >40 marked by a high level of blood flow in meso-hyipogastric area, especially in the field of hernial ring, suprapubic and groin area, with significantly low blood supply and a significant weakening of the trophic tissue at a level above the navel to the costal arches. At the same time in patients with III degree obesity and IV stage morbid obesity century the most active visualization of vessels was defined in the lower anterior abdominal wall, the diameter of the vessels was significantly increased as the number of vessels with venous blood type. Dermatolipectomy was performed mainly according Küster methods in 10 (21.8 %) patients with a vertical excision of skin with subcutaneous fat, Jolly, Thorek in 32 (69.6 %) patients with the removal of tissues by horizontal access, and in patients with severe anterior abdominal skin excess wall dermatolipectomy was performed combined with like T-access after Castansres–Goethel 4 (8.7 %). We believe a promising performance of simultaneous dermatolipectomy at allogernioplasty about POVH under morbid obesity, taking into account peculiarities of blood supply to the subcutaneous fat of the anterior abdominal wall by reducing the area skeleting subcutaneous fat layer and performing a vertical less traumatic, lower horizontal, in rare cases, combined dermatolipectomy that in turn minimizes the risk of postoperative complications.
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